Gender-affirming care

Helping you get the care you need.

Helping you get the care you need.

Healthcare Navigation

In Ōtautahi Christchurch and Waitaha Canterbury, everything starts with your GP. We can help you navigate the health system, find you an affirming GP, and let you know what's available publicly and privately - and how to get it.

A community based approach

Waitaha Canterbury has a primary-care, community-based system for accessing gender-affirming care, meaning that everything starts with your GP, rather than needing to visit a centralised or specialised clinic. We're working towards every GP in the region having at least a basic understanding of gender-affirming care or knowing where to refer to, meaning that you can see your usual GP and access the care you need.

This means lower wait times and fewer barriers to accessing gender-affirming care.

Not everyone has a GP, and not everyone feels comfortable with their GP - if you'd like some recommendations for friendly GPs near you, please get in touch.

Remember, if you run into any issues accessing gender-affirming healthcare, or get stuck - please let us know and we'll do our very best to un-stick you!

So, what's available?

In Waitaha Canterbury, the following is available and publicly funded:

  • gender-affirming hormone therapy (GAHT) and puberty blockers

  • 'top' surgery - both mastectomy and augmentation

  • orchidectomy

  • oopherectomy and hysterectomy

  • fertility preservation

  • speech and language therapy

  • mental health support

'Bottom' surgery, or gender confirmation, or gender affirmation surgery (ie vaginoplasty and phalloplasty) are publicly funded through the national High Cost Treatment Pool.

Hair removal and laser therapy are not publicly funded, but can be accessed through WINZ.

Hormones and puberty blockers

The pathway to access either gender-affirming hormone therapy or puberty blockers depends on your age.

  • If you're over 20, you may be able to access hormone therapy through an informed consent model with your GP or primary care team, removing the need for a readiness assessment or an appointment with an endocrinologist at the hospital.

    The best way to start is to have a conversation with your GP, who will either be able to begin the informed consent process, or will be able to refer you to one of Waitaha Canterbury's prescribing GPs to get you started. There's funding attached to this referral, so you won't have to pay more than you usually would with your normal GP.

    It may take a few appointments with your GP before you receive a script for gender-affirming hormones. Your GP will talk with you about your goals, what support you have around you, and about your fertility options, as well as do a baseline blood test.

    It's important to know that informed consent is not a 'gatekeeping' process, but instead a collaborative one between you and your primary care practitioner - being as open and honest as you feel comfortable about your gender, your wellbeing, and your gender affirmation goals will help your doctor ensure you're getting the best possible care.

    Many doctors will follow the new Primary Care Gender Affirming Hormone Therapy Initiation Guidelines, which you can read here.

  • If you're under 20, the pathway still begins with a conversation with your GP. You'll need what's called a 'readiness assessment' before starting either hormone therapy or puberty blockers. These are publicly funded, and are carried out at the University of Canterbury's Psychology Centre.

    Previous pathways to accessing this care have been arduous and seen as 'gate-keeping' - lots of us in the community have seen these assessments as a test to see if we're 'trans enough' for treatment. It's important to know that a lot has changed - now, these assessments are an opportunity to talk with a mental health professional with a good understanding of gender diversity about you, your life, your gender, and your goals.

    They might ask you questions about your home, family, or social life, and your health and wellbeing - this is so we can make sure you have all the support you need as you begin this journey, not so that the system can say 'no' to you accessing treatment. It's a great opportunity to check in with yourself, be as open and honest as you feel comfortable being, and access further support.

    After a readiness assessment, your GP can then refer you to paediatrics (if you're under 15) or endocrinology (15-19) to initiate either puberty blockers or hormones. Your GP will then continue this prescription.

    For healthcare providers - information about this new pathway is available on HealthPathways.

Surgery

The pathways to access surgery vary depending on which gender-affirming surgery you would like. It's important to know that the wait times for surgery can vary. Gender-affirming surgeries face the same pressures the wider healthcare system does - delays affecting other surgeries might also affect gender-affirming surgeries.

There are currently significant delays to surgeries across the health system - please speak to your GP, who will be able to find out the most relevant and recent information for you.

You will need to have had a readiness assessment at some point to access these surgeries - if you've already had one to access hormone therapy, you can use that one. If you haven't had one, you'll need to get one before referral - unfortunately, readiness assessments for surgery aren't publicly funded, so you'll need to get one privately.

  • Mastectomy is publicly funded for trans and non-binary people in Waitaha Canterbury.

    You must be 18 or over to access this surgery; be a non-smoker and nicotine-free for at least 3 months; and have a BMI less than 32.

    There is no requirement for hormone therapy before having a mastectomy.

    To access this surgery, your GP will refer you to the surgical department.

  • Waitaha Canterbury is one of the few regions in Aotearoa to have funded access to breast augmentation, typically for people who identify as trans feminine who are dissatisfied with their breast growth through gender-affirming hormone therapy.

    You must be 18 or over to access this surgery; be a non-smoker and nicotine-free for at least 3 months; and have a BMI less than 32.

    There is a requirement of being on hormones for at least two years before you're eligible for this surgery - this is because estrogen-based hormone therapy can help with breast growth.

    To access this surgery, your GP will refer you to the surgical department.

  • Orchidectomy (removal of the testicles), oopherectomy (removal of the ovaries), and hysterectomy (removal of the uterus) are all publicly funded in Waitaha Canterbury.

    You must be 18 years or older to access these surgeries; be a non-smoker and nicotine-free for at least 3 months; and have been on hormone therapy for at least 2 years.

    To access this surgery, your GP will refer you to the surgical department.

Fertility preservation

Fertility preservation is funded in Waitaha Canterbury, but at different stages for sperm storage and egg retrieval and storage.

  • For people who produce sperm, sperm storage is funded when you begin gender-affirming hormone therapy. This is because estrogen-based hormone therapy has a significant likelihood of negatively affecting your fertility long-term, even when you stop taking estrogen. Estrogen-based hormone therapy may result in permanent loss of fertility.

  • For people who produce eggs, egg retrieval and storage is only funded in Waitaha Canterbury in conjunction with an oophorectomy, removal of the ovaries. This is because testosterone-based hormone therapy doesn't have as significant an effect on your fertility as estrogen does.

    Testosterone can often cause ovarian suppression - stopping monthly bleeding - but this can resume on stopping testosterone. It's important to note that testosterone is not a contraceptive - you can still get pregnant while taking T. Testosterone negatively affects a fetus, so if you're taking T and having the kinds of sex that could get you pregnant, you should consider another contraceptive. You will need to stop taking testosterone if you want to become pregant.

    Egg quality is not affected by testosterone, and egg retrieval can happen at the time of the desired pregnancy, so retrieval and storage is only funded at the time of an oophorectomy.

Speech and language therapy

Speech and language therapy is publicly funded for trans and non-binary people in Waitaha Canterbury. We're lucky to have a specialist gender-diverse speech clinic at the University of Canterbury - this is voice therapy specifically for trans and non-binary folk, provided by practitioners with expertise and students wanting to learn how to provide great care to gender diverse people.

The University speech clinic accepts referrals directly (you can email them at cmds-clinic@canterbury.ac.nz), but we recommend asking your GP to refer you to ensure you access the public funding for this service.

Mental health support

We know our trans and non-binary whānau often experience poorer health and wellbeing outcomes compared to our cisgender whānau, particularly when it comes to our mental health. This is due to something called 'minority stress' - the additional stress we face navigating a world that is not set up to acknowledge, affirm, and support trans and non-binary folks. Mental distress is not an inherent part of being trans or non-binary.

The Waitaha Canterbury health system acknowledges our additional needs in supporting our mental wellbeing, so every transgender, non-binary, gender diverse, or questioning person in Waitaha can access psychology or peer support free of charge. This is available through a programme called the Trans Wellness Package.

Qtopia provides peer support under this programme - we're here to help you with whatever you need. Most people come to us for one (or more) of three things:

  • practical support on your journey of gender recognition, whether it's help navigating the healthcare system, coming out, changing your name, or more.

  • support with your wellbeing, and helping you implement the things we know can help.

  • social support and connection to community - having someone to catch up with over a cuppa can make a world of difference.

But our peer support service is guided by you, and what you need. We're flexible, too - we can meet when and where suits you best. Lots of our clients enjoy going on regular walks, or going shopping for some affirming clothing - we're not constrained to offices and meeting rooms.

If you feel like you're in need of support beyond peer support, and would like to see a psychologist, that's funded under the package too. All the psychologists providing care under the package have experience supporting trans and non-binary people, so you know you'll be in good hands. If you like, you can access both peer support and psychology at the same time.

The Trans Wellness Package is available through a GP referral - ask your GP to refer you to 'Transgender Mental Health Support'.